Ruchi Mathur, MD, FRCP(C) is an Attending Physician with the Division of Endocrinology, Diabetes and Metabolism and Associate Director of Clinical Research, Recruitment and Phenotyping with the Center for Androgen Related Disorders, Department of Obstetrics and Gynecology at Cedars-Sinai Medical Center.
Dr. Shiel received a Bachelor of Science degree with honors from the University of Notre Dame. There he was involved in research in radiation biology and received the Huisking Scholarship. After graduating from St. Louis University School of Medicine, he completed his Internal Medicine residency and Rheumatology fellowship at the University of California, Irvine. He is board-certified in Internal Medicine and Rheumatology.
The early symptoms of untreated diabetes are related to
elevated blood sugar levels, and loss of glucose in the urine. High amounts of
glucose in the urine can cause increased urine output and lead to
dehydration.
Dehydration causes increased thirst and water consumption.
The inability of
insulin to perform normally has effects on protein, fat and carbohydrate
metabolism. Insulin is an
anabolic hormone, that is, one that encourages storage of fat and protein.
A
relative or absolute insulin deficiency eventually leads to
weight loss despite an
increase in appetite.
Some untreated diabetes patients also complain of fatigue,
nausea and
vomiting.
Patients with diabetes are prone to developing infections
of the bladder, skin, and vaginal areas.
Fluctuations in blood
glucose levels can lead to blurred vision. Extremely elevated glucose levels can
lead to lethargy and
coma.
How is diabetes diagnosed?
The fasting blood glucose (sugar) test is the preferred way to diagnose
diabetes. It is easy to perform and convenient. After the person has fasted
overnight (at least 8 hours), a single sample of blood is drawn and sent to the
laboratory for analysis. This can also be done accurately in a doctor's office
using a glucose meter.
Normal fasting plasma glucose levels are less than 100
milligrams per deciliter (mg/dl).
Fasting plasma glucose levels of more than 126
mg/dl on two or more tests on different days indicate diabetes.
A random blood glucose test
can also be used to diagnose diabetes. A blood glucose level of 200 mg/dl or
higher indicates diabetes.
When fasting blood glucose stays above 100mg/dl, but in
the range of 100-126mg/dl, this is known as impaired fasting glucose (IFG).
While patients with IFG do not have the diagnosis of diabetes, this condition carries with it
its own risks and concerns, and is addressed elsewhere.
The oral glucose tolerance test
Though not routinely used anymore, the
oral glucose tolerance test
(OGTT)
is a gold standard for making the diagnosis of type 2
diabetes. It is still commonly used for diagnosing gestational diabetes and in
conditions of pre-diabetes, such as
polycystic ovary syndrome. With an
oral glucose tolerance test, the person fasts overnight (at least eight but not more
than 16 hours). Then first, the fasting plasma glucose is tested. After this
test, the person receives 75 grams of glucose (100 grams for pregnant women). There are
several methods employed by obstetricians to do this test, but the one described
here is standard. Usually, the glucose is in a sweet-tasting liquid that the
person drinks. Blood samples are taken at specific intervals to measure the
blood glucose.
For the test to give reliable results:
the person must be
in good health (not have any other illnesses, not even a cold).
the person
should be normally active (not lying down, for example, as an inpatient in a hospital), and
the person should
not be taking medicines that could affect the blood glucose.
For three days before
the test, the person should have eaten a diet high in carbohydrates (200-300
grams per day).
The morning of the test, the person should not smoke or drink
coffee.
The classic oral glucose tolerance test measures blood
glucose levels five times over a period of three hours. Some physicians simply get a
baseline blood sample
followed by a sample two hours after drinking the glucose solution. In a person
without diabetes, the glucose levels rise and then fall quickly. In someone with
diabetes, glucose levels rise higher than normal and fail to come back down as
fast.
People with glucose levels between normal and diabetic have impaired glucose
tolerance (IGT). People with impaired glucose tolerance do not have diabetes,
but are at high risk for progressing to diabetes. Each year, 1%-5% of people
whose test results show impaired glucose tolerance actually eventually develop
diabetes. Weight loss and
exercise may help people with impaired glucose
tolerance return their glucose levels to normal. In addition, some physicians
advocate the use of medications, such as
metformin (Glucophage), to help
prevent/delay the onset of overt diabetes.
Recent studies have shown that
impaired glucose tolerance itself may be a risk factor for the development of
heart disease. In the medical community, most physicians are now understanding
that impaired glucose tolerance is nor simply a precursor of diabetes, but is
its own clinical disease entity that requires treatment and monitoring.
Evaluating the results of the oral glucose tolerance test
Glucose tolerance tests may lead to one of the following diagnoses:
Normal response: A person is said to have a normal response when the 2-hour
glucose level is less than 140 mg/dl, and all values between 0 and 2 hours are
less than 200 mg/dl.
Impaired glucose tolerance: A person is said to have impaired glucose
tolerance when the fasting plasma glucose is less than 126 mg/dl and the 2-hour
glucose level is between 140 and 199 mg/dl.
Diabetes: A person has diabetes when two diagnostic tests done on different
days show that the blood glucose level is high.
Gestational diabetes: A woman has gestational diabetes when she has any two
of the following: a 100g OGTT, a fasting plasma glucose of more than 95 mg/dl, a
1-hour glucose level of more than 180 mg/dl, a 2-hour glucose level of more than
155 mg/dl, or a 3-hour glucose level of more than 140 mg/dl.
Diabetes - Symptoms at Onset of DiseaseQuestion: The symptoms of diabetes can vary greatly from patient to patient. What were your symptoms at the onset of your disease?
One in every 20 people develop a kidney stone at some point in their life. A kidney stone is a hard mineral and crystalline material formed within the kidney or urinary tract. Kidney stones symptoms and signs are, blood in the urine and pain in the abdomen, flank (lower back), or groin. A number of different conditions can lead to kidney stones including: gout, hypercalciuria, people with inflammatory bowel disease, kidney disease, and hypoparathyroidism. Some medications also increase the risk of kidney stones.
Liver cancer is the fifth most common cancer in the world and the majority of patients with liver cancer will die within one year as a result. Patients with associated cirrhosis caused by chronic hepatitis B or C infections, alcohol, and hemochromatosis are at the greatest risk of developing liver cancer. Many patients with liver cancer do not develop symptoms until the advanced stages of the tumor which usually makes prognosis poor. The combination of an imaging study (ultrasound, CT, or MRI scans) and an elevated blood level of alpha-fetoprotein will most effectively diagnose liver cancer, while a liver biopsy can make a definitive diagnosis. Medical treatments, including chemotherapy, chemoembolization, ablation, and proton beam therapy, are not very effective. Surgical removal of the tumor or a liver transplant may be most effective in certain cases.
Blood clots can occur in the venous and arterial vascular system. Blood clots can form in the heart, legs, arteries, veins, bladder, urinary tract and uterus. Risk factors for blood clots include high blood pressure and cholesterol, diabetes, smoking, and family history. Symptoms of a blood clot depend on the location of the clot. Some blood clots are a medical emergency. Blood clots are treated depending upon the cause of the clot. Blood clots can be prevented by lowering the risk factors for developing blood clots.
A sty (sometimes spelled stye) is a tender, painful red bump located at the base of an eyelash or on, inside, or under the eyelid, which is the result of an acute infection of the oil glands of the eyelid. Complications of a sty can be blepharitis and chalazion.
Cellulitis is an acute spreading bacterial infection below the surface of the skin characterized by redness, warmth, inflammation, and pain. The most common cause of cellulitis is the bacteria Staph (Staphylococcus aureus).
A stroke results from impaired oxygen delivery to brain cells via the bloodstream. A stroke is also referred to as a CVA, or cerebrovascular incident. Symptoms of stroke include: sudden numbness or weakness of the face, arm or leg. Sudden confusion, trouble speaking or understanding. Sudden trouble seeing in one or both eyes, sudden trouble walking, dizziness, or loss of balance, and/or sudden severe headache with no known cause. A TIA, or transient ischemic attack is a short-lived temporary impairment of the brain caused by loss of blood supply. Stroke is a medical emergency.
Athlete's foot (tinea pedis) is a skin infection caused by the ringworm fungus. Symptoms include itching, burning, cracking, peeling, and bleeding feet. Treatment involves keeping the feet dry and clean, wearing shoes that can breathe, and using medicated powders to keep your feet dry.
Cholesterol is naturally produced by the body, and is a building block for cell membranes and hormones. Low-density lipoprotein (LDL) cholesterol is the "bad" cholesterol, conversely, high-density lipoprotein (HDL) cholesterol is the "good" cholesterol. High cholesterol treatment includes lifestyle changes (diet and exercise), and medications such as statins, bile acid resins, and fibric acid derivatives.
Thrush is an infection of the mouth caused by the candida fungus. Symptoms of Thrush include pain or difficulty swallowing, a feeling that food gets stuck in the throat, and fever.
Itching can be a common problem. Itches can be localized or generalized. There are many causes of itching to include: infection (jock itch, vaginal itch), disease (hyperthyroidism, liver or kidney), reactions to drugs, and skin infestations (pubic or body lice). Treatment for itching varies depending on the cause of the itch.
Heart attack happens when a blood clot completely obstructs a coronary
artery supplying blood to the heart muscle. A heart attack can cause chest pain, heart failure, and electrical
instability of the heart.
Hypoglycemia is a syndrome caused by low blood sugar. Symptoms of hypoglycemia include palpitations, trembling, intense hunger, sweating, nervousness, and weakness. Consuming lifesavers, table sugar, soda, and juice are good treatment options for hypoglycemia.
Retinal detachment is the separation of the retina from its attachments to the underlying eye tissue. Symptoms of retinal detachment include flashing lights and floaters. Highly nearsighted young adults and those who've had cataract surgery are at higher risk for retinal detachment.
Restless leg syndrome (RLS or restless legs syndrome) is a common cause for painful legs that typically eases with motion, and becomes worse and more noticeable at rest. This characteristic nighttime worsening can frequently lead to insomnia. Treatment of the symptoms of restless leg syndrome is generally with medication as well as treating any underlying condition causing restless leg syndrome.
A miscarriage is any pregnancy that ends spontaneously before the fetus can survive. Miscarriage usually occurs before the 13th week of pregnancy. The cause of a miscarriage cannot always be determined. The most common causes of a miscarriage in the first trimester are collagen vascular disease (lupus), hormonal problems, diabetes, chromosomal abnormalities, and congenital abnormalities of the uterus.
Carpal tunnel syndrome is a condition in which irritation of the wrist's median nerve causes tingling and numbness of the thumb, index, and the middle fingers. This condition is known as tarsal tunnel syndrome in the ankles and feet. Treatment of carpal tunnel syndrome depends on the severity of the symptoms and the nature of any disease that might be causing the symptoms.
Impotence, also known as erectile dysfunction, is a common
problem among men characterized by the consistent inability to sustain an
erection sufficient for sexual intercourse or the inability to achieve
ejaculation, or both. Impotence can have emotional causes but most often it is
due to a physical problem.
Insulin resistance is the diminished ability of cells to respond to the action of insulin in transporting glucose (sugar) from the bloodstream into muscle and other tissues. Causes of insulin can include conditions such as stress, obesity, metabolic syndrome, and steroid use. Some of the risk factors for insulin resistance include fatty liver, heart disease, strokes, peripheral vascular disease, high cholesterol, and smoking. Treatment for insulin resistance are lifestyle changes and if necessary, medication.
Overactive bladder is a sudden involuntary contraction of the muscle wall of the bladder causing urinary urgency (an immediate unstoppable need to urinate). Overactive bladder is is a form of urinary incontinence. Treatment options may include Kegel exercises, biofeedback, vaginal weight training, pelvic floor electrical stimulation, behavioral therapy, and medications.
Vancomycin-resistant enterococci (VRE) infection is the most common type of infection acquired by patients while hospitalized. Patients at risk for VRE are those who are already ill, and hospitalized, including individuals with diabetes, elderly, ICU patients, kidney failure patients, or patients requiring catheters. Enterococci can survive for months in the digestive tract and female genital tract. Other risk factors for acquiring VRE include those how have been previously treated with vancomycin and combinations of other antibiotics. Treatment of VRE is generally with other antibiotics other than vancomycin. Prevention of VRE can be achieved by proper hand hygiene.
Dysphagia or difficulty in swallowing, swallowing problems. Dysphagia is due to problems in nerve or muscle control. It is common, for example, after a stroke. Dysphagia compromises nutrition and hydration and may lead to aspiration pneumonia and dehydration.
Heart disease (coronary artery disease) is caused by a buildup of cholesterol deposits in the coronary arteries. Risk factors for heart disease include smoking, high blood pressure, heredity, diabetes, peripheral artery disease, and obesity. Symptoms include chest pain and shortness of breath. There are a variety of tests used to diagnose coronary artery disease. Treatment includes life-style changes, medications, procedures, or surgery.
Hyperglycemia is a serious health problem for diabetics. There are two types of hyperglycemia, 1) fasting, and 2)postprandial or after meal hyperglycemia. Hyperglycemia can also lead to ketoacidosis or hyperglycemic hyperosmolar nonketotic syndrome (HHNS). There are a variety of causes of hyperglycemia in people with diabetes. Symptoms include increased thirst, headaches, blurred vision, frequent urination and more. Treatment can be achieved through lifestyle changes or medications changes. Carefully monitoring blood glucose levels is key to prevention.
Encephalopathy means brain disease, damage, or malfunction. Causes of encephalopathy are varied and numerous. The main symptom of encephalopathy is an altered mental state. Other symptoms include lethargy, dementia, seizures, tremors, and coma. Treatment of encephalopathy depends on the type of encephalopathy (anoxia, diabetic, Hashimoto's, hepatic, hyper - hypotensive, infectious, metabolic, infections, uremic, or Wernicke's) are examples of types of encephalopathy.
Obesity is the state of being well above one's normal weight. A person has traditionally been
considered to be obese if they are more than 20 percent over their ideal weight.
That ideal weight must take into account the person's height, age, sex, and
build.
The major goal in treating diabetes is controlling elevated blood sugar without causing abnormally low levels of blood sugar. Treatment for type 1 diabetes is with insulin, exercise, and a diabetic diet. Treatment for type 2 diabetes is first treated with weight reduction, a diabetic diet, and exercise. When these measures fail to control the elevated blood sugar, oral medications are used. If oral medications are still insufficient, insulin medications are considered.
Diabetic Neuropathy is a complication of diabetes that causes damage to the nerves; this is related to the blood glucose of the body being too high for a long period of time. The four types of neuropathy include peripheral, autonomic, proximal and focal.
The main features of metabolic syndrome include insulin resistance, hypertension (high blood pressure), cholesterol abnormalities, and an increased risk for clotting. Patients are most often overweight or obese. Lifestyle modification such as the Mediterranean diet, exercise, and quitting smoking are the preferred treatment of metabolic syndrome.
Radiculopathy, a condition in which a nerve or nerves along the spine are compressed causing pain, numbness, weakenss, and tingling along the nerve(s). Some causes of radiculopathy include bone spurs, disc hernation, osteoarthritis, tumors, infection, and neuropathy. Treatment depends on the are of nerve compression. Surgery is generally not required.
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